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©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
Trends and outcomes of pancreaticoduodenectomy for periampullary tumors: A 25-year single-center study of 1000 consecutive cases
Ayman El Nakeeb, Waleed Askar, Ehab Atef, Ehab El Hanafy, Ahmad M Sultan, Tarek Salah, Ahmed shehta, Mohamed El Sorogy, Emad Hamdy, Mohamed El Hemly, Ahmed A El-Geidi, Tharwat Kandil, Mohamed El Shobari, Talaat Abd Allah, Amgad Fouad, Mostafa Abu Zeid, Ahmed Abu El Eneen, Nabil Gad El-Hak, Gamal El Ebidy, Omar Fathy, Ahmed Sultan, Mohamed Abdel Wahab
Ayman El Nakeeb, Waleed Askar, Ehab Atef, Ehab El Hanafy, Ahmad M Sultan, Tarek Salah, Ahmed shehta, Mohamed El Sorogy, Emad Hamdy, Mohamed El Hemly, Ahmed A El-Geidi, Tharwat Kandil, Mohamed El Shobari, Talaat Abd Allah, Amgad Fouad, Mostafa Abu Zeid, Ahmed Abu El Eneen, Nabil Gad El-Hak, Gamal El Ebidy, Omar Fathy, Ahmed Sultan, Mohamed Abdel Wahab, Gastroenterology surgical center, Mansoura University, Mansoura 35516, Egypt.
Author contributions: El Nakeeb A designed the research; El Nakeeb A, Askar W, Atef E, El Hanafy E, Sultan AM, Salah T, Shehta A, El Sorogy M, Hamdy E, El Hemly M, El-Geidi AA, Kandil T, El Shobari M, Allah TA, Fouad A, Zeid MA, El Eneen AA, El-Hak NG, El Ebidy G, Fathy O, Sultan A and Wahab MA performed the research; El Nakeeb A analyzed the data; El Nakeeb A, Shehta A and El Sorogy M wrote the paper.
Institutional review board statement: This study was approved by the Institutional Review Board of Mansoura University.
Informed consent statement: Informed consent was obtained from all patients to undergo pancreaticoduodenectomy after a careful explanation of the nature of the disease and possible complications.
Conflict-of-interest statement: All authors declare no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Ayman El Nakeeb, Professor, Gastroenterology Surgical Center, Mansoura University, Mansoura 35516, Egypt.
elnakeebayman@man.edu.eg
Telephone: +2-0100-6752021
Received: May 16, 2017
Peer-review started: May 18, 2017
First decision: June22, 2017
Revised: June 28, 2017
Accepted: August 2, 2017
Article in press: August 2, 2017
Published online: October 14, 2017
Processing time: 153 Days and 10.8 Hours
AIM
To evaluate the evolution, trends in surgical approaches and reconstruction techniques, and important lessons learned from performing 1000 consecutive pancreaticoduodenectomies (PDs) for periampullary tumors.
METHODS
This is a retrospective review of the data of all patients who underwent PD for periampullary tumor during the period from January 1993 to April 2017. The data were categorized into three periods, including early period (1993-2002), middle period (2003-2012), and late period (2013-2017).
RESULTS
The frequency showed PD was increasingly performed after the year 2000. With time, elderly, cirrhotic and obese patients, as well as patients with uncinate process carcinoma and borderline tumor were increasingly selected for PD. The median operative time and postoperative hospital stay decreased significantly over the periods. Hospital mortality declined significantly, from 6.6% to 3.1%. Postoperative complications significantly decreased, from 40% to 27.9%. There was significant decrease in postoperative pancreatic fistula in the second 10 years, from 15% to 12.7%. There was a significant improvement in median survival and overall survival among the periods.
CONCLUSION
Surgical results of PD significantly improved, with mortality rate nearly reaching 3%. Pancreatic reconstruction following PD is still debatable. The survival rate was also improved but the rate of recurrence is still high, at 36.9%.
Core tip: Pancreaticoduodenectomy (PD) is a complex abdominal procedure. The hospital mortality rate has decreased to less than 5%; however, the rate of postoperative morbidities remains high, from 40% to 50%. Pancreatic reconstruction following PD is still debatable. The long survival rate after PD is clearly improved with time but still poor. Frequency showed PD is increasingly performed. With time, elderly, cirrhotic and obese patients, and patients with uncinate process carcinoma and borderline tumor are increasingly selected for PD. Median operative time and postoperative hospital stay decreased significantly. Hospital mortality declined significantly, from 6.6% to 3.1%. Postoperative complications significantly decreased.
